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Breves et decouvertes sur le sommeil

Voici un aperçu des études liées au sommeil parues ou en instance de parution et annoncées sur la base PuBmed.

Sommeil et respiration
·         La respiration buccale (upper airway obstruction) peut avoir des conséquences graves sur le développement normal de la face et sur la santé en général. C’est ce qu’affirme une étude parue dans la revue General Dentistry. Les enfants respirant par la bouche, outre le risque de développer une dysmorphie de la face, connaissent souvent un sommeil de moindre qualité et peuvent développer ses corrélats : troubles de la croissance, performances scolaires faibles, ou déficit de l’attention. D’où la nécessité de développer le suivi médical de la respiration buccale, chez les adultes et les enfants, dès 5 ans.
 
·         Quel mécanisme est à l’origine de l’association fréquente chez l'enfant entre des antécédents d'asthme ou de respiration sifflante et des troubles respiratoires obstructifs du sommeil ? La revue Pediatric Pulmunology publie une étude visant à déterminer l’étiologie de cette association en mettant en évidence le rôle de l’hypertrophie amygdalienne. 
Sommeil et neurologie
·         La revue de neurologie Brain publie une mise à l’épreuve de l’hypothèse de la coexistence de troubles du comportement en sommeil REM et d’une cataplexie chez les patients atteints de narcolepsie elle-même issue d’une déficience en hypocrétine-1.
 Sommeil et chronobiologie
·         Une revue de la littérature à paraître dans la revue Gerontology s’interroge sur les rapports entre sommeil, rythmes circadiens et immunité. Un modèle d’interprétation mécanisme est proposé suggérant que le sommeil stimule les cellules immunitaires d’une part et produit un signal temporel pour les horloges circadiennes de l’hématopoïèse.  Ainsi une perturbation du sommeil entraîne-t-elle une désynchronisation de ces horloges et à travers ce dysfonctionnement, dérégule les réponses du système immunitaire.
Sommeil et douleur
·         La revue The Clinical Journal of Pain s’intéresse aux caractéristiques du sommeil et aux motifs des plaintes de mauvais sommeil chez des personnes âgées souffrant de douleurs chroniques. Dans ce contexte, deux méthodologies sont investies : l’actigraphie et le témoignage du vécu des patients.
   
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General  Dentistry 2010 Jan-Feb;58(1):18-25.
Mouth breathing: Adverse effects on facial growth, health, academics, and behavior.
Jefferson Y.
The vast majority of health care professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity. It is important for the entire health care community (including general and pediatric dentists) to screen and diagnose for mouth breathing in adults and in children as young as 5 years of age. If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.
PMID: 20129889 [PubMed - as supplied by publisher]
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Pediatric Pulmonology, 2010 Feb 3. [Epub ahead of print]
Associations of tonsillar hypertrophy and snoring with history of wheezing in childhood.
Kaditis AG, Kalampouka E, Hatzinikolaou S, Lianou L, Papaefthimiou M, Gartagani-Panagiotopoulou P, Zintzaras E, Chrousos G.
First University Department of Pediatrics, Pediatric Pulmonology Clinic, University of Athens School of Medicine, Aghia Sophia Children's Hospital, Athens, Greece.
BACKGROUND: Reports in adults and children have correlated history of wheezing or asthma with the presence of obstructive sleep-disordered breathing but the mechanism of this epidemiologic association is unknown. The goal of the present study was to examine whether tonsillar hypertophy can explain this association. METHODS: Children were recruited from the Emergency Department and the Pediatric Pulmonology Clinic. History of wheezing requiring treatment (explanatory variable) and snoring >/=1 night/week (outcome) were recorded and presence of tonsillar hypertrophy (outcome) was assessed. RESULTS: Four hundred forty-two children were recruited (mean age: 7.6 +/- 3.6 years) and 210 of them had history of wheezing. History of wheezing was significantly associated with the presence of tonsillar hypertrophy and snoring even after adjustment for age, gender, obesity, and passive smoking [odds ratio (95% confidence interval): 2.23 (1.37-3.63); P = 0.001 and 1.73 (1.12-2.67); P = 0.013, respectively]. When only children with tonsillar hypertrophy were considered (n = 92), history of wheezing was significantly related to the presence of snoring, whereas in subjects without tonsillar hypertrophy (n = 350) wheezing did not affect snoring [odds ratio: 2.76 (1.10-6.93); P = 0.031 and 1.49 (0.92-2.43); P = 0.107, respectively]. CONCLUSIONS: Children with history of wheezing have more frequently tonsillar hypertrophy than those without wheezing. Tonsillar hypertrophy may mediate at least in part the reported association between asthma and obstructive sleep-disordered breathing in childhood. Pediatr Pulmonol. (c) 2010 Wiley-Liss, Inc.
PMID: 20131382 [PubMed - as supplied by publisher]
 
Brain. 2010 Feb 3. [Epub ahead of print]
Rapid eye movement sleep behaviour disorder in patients with narcolepsy is associated with hypocretin-1 deficiency.
Knudsen S, Gammeltoft S, Jennum PJ.
1 Danish Center for Sleep Medicine, University of Copenhagen, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
Rapid eye movement sleep behaviour disorder is characterized by dream-enacting behaviour and impaired motor inhibition during rapid eye movement sleep. Rapid eye movement sleep behaviour disorder is commonly associated with neurodegenerative disorders, but also reported in narcolepsy with cataplexy. Most narcolepsy with cataplexy patients lack the sleep-wake, and rapid eye movement sleep, motor-regulating hypocretin neurons in the lateral hypothalamus. In contrast, rapid eye movement sleep behaviour disorder and hypocretin deficiency are rare in narcolepsy without cataplexy. We hypothesized that rapid eye movement sleep behaviour disorder coexists with cataplexy in narcolepsy due to hypocretin deficiency. In our study, rapid eye movement sleep behaviour disorder was diagnosed by the International Classification of Sleep Disorders (2nd edition) criteria in 63 narcolepsy patients with or without cataplexy. Main outcome measures were: rapid eye movement sleep behaviour disorder symptoms; short and long muscle activations per hour rapid eye movement and non-rapid eye movement sleep; and periodic and non-periodic limb movements per hour rapid eye movement and non-rapid eye movement sleep. Outcome variables were analysed in relation to cataplexy and hypocretin deficiency with uni- and multivariate logistic/linear regression models, controlling for possible rapid eye movement sleep behaviour disorder biasing factors (age, gender, disease duration, previous anti-cataplexy medication). Only hypocretin deficiency independently predicted rapid eye movement sleep behaviour disorder symptoms (relative risk = 3.69, P = 0.03), long muscle activations per hour rapid eye movement sleep (ln-coefficient = 0.81, P < 0.01), and short muscle activations per hour rapid eye movement sleep (ln-coefficient = 1.01, P < 0.01). Likewise, periodic limb movements per hour rapid eye movement and non-rapid eye movement sleep were only associated with hypocretin deficiency (P < 0.01). A significant association between hypocretin deficiency and cataplexy was confirmed (P < 0.01). In a sub-analysis, hypocretin deficiency suggested the association of periodic limb movements and rapid eye movement sleep behaviour disorder outcomes (symptoms, non-periodic short and long muscle activity) in rapid eye movement sleep. Our results support the hypothesis that hypocretin deficiency is independently associated with rapid eye movement sleep behaviour disorder in narcolepsy. Thus, hypocretin deficiency is linked to the two major disturbances of rapid eye movement sleep motor regulation in narcolepsy: rapid eye movement sleep behaviour disorder and cataplexy. Hypocretin deficiency is also significantly associated with periodic limb movements in rapid eye movement and non-rapid eye movement sleep, and provides a possible pathophysiological link between rapid eye movement sleep behaviour disorder and periodic limb movements in narcolepsy. The study supports the hypothesis that an impaired hypocretin system causes a general instability of motor regulation during wakefulness, rapid eye movement and non-rapid eye movement sleep in human narcolepsy.
PMID: 20129934 [PubMed - as supplied by publisher]
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Gerontology. 2010 Feb 3. [Epub ahead of print]
Sleep, Immunity, and Circadian Clocks: A Mechanistic Model.
Bollinger T, Bollinger A, Oster H, Solbach W.
Institute of Medical Microbiology and Hygiene, University of Luebeck, Luebeck, Germany.
The lack of sufficient amounts of sleep is a hallmark of modern living, and it is commonly perceived that in the long run this makes us sick. An increasing amount of scientific data indicate that sleep deprivation has detrimental effects on immune function. Conversely, immune responses feedback on sleep phase and architecture. Several studies have investigated the impact of short-term sleep deprivation on different immune parameters, whereas only a few studies have addressed the influence of sleep restriction on the immune system. In many cases, sleep deprivation and restriction impair immune responses by disrupting circadian rhythms at the level of immune cells, which might be a consequence of disrupted endocrine and physiological circadian rhythms. Little is known about the mechanisms underlying the circadian regulation of immunity, but recent studies have suggested that local as well as central circadian clocks drive the rhythms of immune function. In this review, we present a mechanistic model which proposes that sleep (through soluble factors and body temperature) primes immune cells on the one hand, and, on the other hand, provides a timing signal for hematopoietic circadian clocks. We hypothesize that chronic sleep disruption desynchronizes these clocks and, through this mechanism, deregulates immune responses. Copyright © 2010 S. Karger AG, Basel.
PMID: 20130392 [PubMed - as supplied by publisher]
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Clinical Journal of Pain. 2010 Feb; 26(2):132-7.
Characteristics of sleep in older persons with chronic pain: a study based on actigraphy and self-reporting.
Lunde LH, Pallesen S, Krangnes L, Nordhus IH.
The Pain Clinic, Haukeland University Hospital, Bergen, Norway. liheilu@hotmail.com
OBJECTIVES: To examine characteristics of sleep and sleep complaints in older persons with chronic pain, as compared to older persons with neither sleep complaints nor chronic pain, on the basis of objective and subjective sleep assessment. METHODS: Forty-three older adults (60 to 81 y) with chronic pain and 29 older adults (55 to 85 y) without sleep complaints and chronic pain participated, completing a self-report measure of sleep quality, and a measure of sleepiness. The participants kept sleep diaries for 2 weeks, and wore an actigraph for the same period of time. An actigraph is a motion-monitoring device detecting sleep-wake patterns by measuring activity levels. RESULTS: The sample with chronic pain demonstrated significantly poorer sleep quality and more symptoms of disruptive sleep and poorer daytime functioning on subjective sleep measures than the comparison group. Actigraphy recordings and sleep diary data showed that participants with chronic pain spent significantly more time in bed than participants without sleep complaints. They also had lower sleep efficiency than the participants without sleep complaints, based on both a sleep diary and actigraphic data, although the actigraphic data were only nearly significant. The duration of sleep, based on both actigraphy and a sleep diary, was not significantly different between the 2 groups. DISCUSSION: Sleep complaints such as disruptive sleep and problems initiating and maintaining sleep, and impairment in daytime functioning, are prevalent in older adults with chronic pain. Sleep and sleep complaints should be addressed to a much greater extent in this patient group.

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Groupe Santé Sommeil

Le groupe médical Santé Sommeil a pour vocation de diagnostiquer et traiter les troubles du sommeil et de la veille chez l’adulte et l’enfant.